Last year the Boston Globe reported that health benefits for workers at Hannaford, a supermarket chain with stores here in the Capital District, included the option of hip and knee replacement surgery performed in Singapore. One day while grocery shopping at the Delmar Hannaford I asked several employees what they thought. They weren’t impressed.

To learn that a local company was forced by soaring health care costs to ask its workers to consider traveling overseas for elective surgery seemed yet another symptom of a health care system failing because it puts money interests before health. But also ironic. The most vocal critics of single payer health reform, which would remove private health insurance and profiteering from the delivery of care, like to shout that some Canadian patients seek elective procedures in the United States.

In 2005 the Supreme Court of Canada ruled that the province of Quebec could not bar private health insurance from covering the same services as the province’s single payer system, if Canada’s Medicare made patients wait. The case was brought by Dr. Jacques Chaoulli on behalf of his patient who had waited one year for an elective hip replacement surgery.

Thanks to his crusade against the Canadian single payer system Dr. Chaoulli became the darling of the insurance industry and well-funded ideologues hired to champion profiteering at the expense of the sick. He even inspired a few free-market fundamentalists to seek constitutional grounds to abolish Medicare in the United States. Other free-market enthusiasts also took up Dr. Chaoulli’s cry that Canadians would get seen more quickly and receive better care, if only they were allowed to pay privately.

If only.

Jean-Jacques Sauvageau died in the waiting room of a private clinic in Quebec in January 2008. The clinic advertised emergency care. The subsequent investigation has led the provincial coroner to urge the Quebec College of Physicians to issue guidelines to protect patient safety at private clinics.

The physician on duty at the private clinic was Dr. Jacques Chaoulli.

The clinic’s receptionist (who had no medical training) took identifying information and asked Mr. Sauvageau to take a seat. The coroner reported that Mr. Sauvageau then waited 20 to 60 minutes, blue and gasping, his shoulders heaving with each breath. In the Globe and Mail Ingrid Peritz described his death as “a scene that combined tragedy with Monty Python farce:”

…the increasingly alarmed fellow patients could see Mr. Sauvageau was unconscious and alerted the receptionist. Dr. Chaoulli came out, did a cursory examination and concluded the patient was already dead.
He left him sitting in the chair, and told the nurse to phone 911 to report the death.
But the 911 operator pleaded with the nurse to try to revive Mr. Sauvageau. Dr. Chaoulli got on the phone and tried to argue the patient was dead; however, the 911 operator insisted…
…Eventually, ambulance medics arrived and tried in vain to revive the patient.
An autopsy later revealed that Mr. Sauvageau died of a pulmonary embolism and would not have survived anyway. But the coroner said that Dr. Chaoulli had no way of knowing that, and should have tried to perform CPR.

It was Sarah Swain-Lagarde, 22, who called 911 for guidance on how to give the man CPR herself. She was told to lie him down. But when she tried, the nurses told her to stop – no one was to touch the man, they said.
“I’m not a doctor … but when someone is purple and having a hard time breathing he should be helped right away,” said Swain-Lagarde, who had brought her toddler to the clinic for a high fever. “He was in a waiting room surrounded by people. He just stayed on his chair. No one did anything for him.”
Jacques Chaoulli, the doctor who took Sauvageau’s pulse around 4 p.m., testified that he also spoke to Sauvageau, listened for a heartbeat and pinched him. He examined his eyes and his extremities, which were blue, while his face was now white.
But Chaoulli said he did not try to resuscitate him.
“I concluded that this patient must have been dead already a long enough time – I had no way of knowing how long – but long enough,” Chaoulli said.
Chaoulli told a nurse to call 911 so that they could declare him dead officially, he said.
As for why Chaoulli left the body there for what he says was another 10 minutes – he explained he felt the waiting room had become akin to “the scene of a crime.” The death in a public place would require an investigation, he explained, and “the police wouldn’t want us to touch the body.”

Certainly in this case it doesn’t look like Chaoulli’s clinic provided the kind of excellent health care proponents of privatization vaunt. Without a doubt members of the victim’s family must be asking what would have happened had he gone to a hospital emergency room where triage teams are trained to quickly size up a situation. It’s doubtful that a man turning blue would be told to sit and wait on a chair: while there’s no doubt that it can take hours for non-urgent cases to be seen, life-threatening cases are evaluated and treated quickly in hospitals, observers agree.

Mr. Sauvageau’s death reminds us that a person in acute distress, or a person in need of a surgery or care in general, is in no position to predict what care will be required. What kind of society would take the health and illness of human beings as an occasion to shop for a bargain — or a money-making moment for profiteers? Health policies and budgets are best set by the public. The effort to reduce waiting times is no exception.

Sadly for those invested in this odd knock against the Canadian system, the wait times are largely hype. A 2003 study found that the median wait time for elective surgeries in Canada was a little more than four weeks, while diagnostic tests took about three (with no wait times to speak of for emergency surgeries). By contrast, Organisation for Economic Co-operation and Development data from 2001 found that 32 percent of American patients waited more than a month for elective surgery, and 5 percent waited more than four months. That, of course, doesn’t count the millions of Americans who never seek surgery, or even the basic care necessary for a diagnosis, because they lack health coverage. If you can’t see a doctor in the first place, you never have to wait for treatment.

Last week the Wall Street Journal reported that, thanks to layoffs, 9 million people have lost their employer-sponsored private health insurance in the United States in the last year. This week the Wall Street Journal reported that the economic crisis had caused an increase in those in the United States who, as Klein put it, “never seek surgery”:

While more uninsured patients strain hospital budgets, many hospitals report fewer inpatient admissions overall. For example, 41% of hospitals reported a moderate decrease in elective procedures, and 18% said the decrease was significant.

More than two years after Quebec legalized private medical coverage for select surgeries, the insurance industry says it has not sold a single policy.
Bill 33 was supposed to allow Quebecers to seek private insurance for faster knee and hip replacements, and cataract surgery.
Yves Millette, senior vice-president of the Canadian Life and Health Insurers’ Association, said no one is buying the policies because they are too expensive…
…Quebec Health Minister Yves Bolduc said the province has sped up wait times so much since the court ruling, it’s no wonder no one wants to pay for private coverage.
“We have such a good access to the surgeries in Quebec, that the industry knows they won’t be able to sell any insurance to anybody,” said Bolduc.

Imagine that. The province of Quebec, with its health system underfunded and in spite of a growing global economic crisis, has successfully shortened wait times for elective surgeries.

Meanwhile in the United States elective surgery is increasingly “off the table” for the uninsured and under-insured. In addition the New York Times reported in March 2009 that more than 85,000 people leave the United States each year, to travel to other countries for elective surgeries.

The waiting room tragedy that befell Mr. Sauvageau, and indeed Dr. Chaoulli, emphasizes our need for public decision-making, public financing and public health services. In the United States and Canada, as in every country, decisions over how best to share health resources belong in the public domain. In Canada we must defend Medicare against privatization. In the United States we need to enact a singlepayernationalhealthprogram.

Single payer is not a perfect system, but it is so much better than the alternative, privatization and profiteering at the expense of the sick.

17 Responses

In the US we need a bipartisan effort from the White House and Congress to reach common sense solutions that will provide affordable health care choices to all Americans.
Our current health care system costs too much, wastes too much, and returns too little value. It is now too common for Americans to have to choose between health care and other necessary living expenses. With health care premiums increasing and the number of uninsured continuing to rise, many newly uninsured find themselves ineligible for new insurance due to preexisting conditions.
We must ensure that affordable health care is available regardless of age or health.
Strengthening Medicare for current and future generations is another essential step in solving our national health problems. We need to lower health care costs for people on Medicare while eliminating the waste, fraud and abuse that result in medical errors and poor care.

Any health care plan that places the interests of the shareholders of several health related industries (especially the insurance industry) ahead of those in need of treatment fails to provide the type of health care the American people deserve. 47+ million uninsured in the country that touts itself as having the most highly advanced health technology in the world, is a crime against reason and logic, and a horrible example of murder for profit.

A very informative and persuasive article that should be widely disseminated. We really need people to flood Washington–I’m talking a million or more—to demand universal, single-payor health care and innundate our Senators and Representatives with letters, e-mails, phone calls and personal visits on a daily basis.

So do we just shut down the private insurance companies and fire everyone? That doesn’t sound feabible either. In a sense the VA is a one payor system. It is antiquated and patients stay much longer on average than non VA hospitals. I know they want to do everything at one, but first we need to reform medical pricing. Why do so many deals need to be struck? Why are hospitals and doctor’s offices discounting up to 60%. There should be a one price for everyone/anyone including the government. Why should Medicare and Medicaid reimburse for a procedure and the hospital lose money, only to regain it from private insurance. The government doesn’t go to GE and pay less than the turbine cost to build. It’s a shame and a sham.

Are you not taking an awful lot for granted here by assuming the Federal Government has the wherewithal and expertise to take on such a program? After all, isn’t this the same government that has done such a horrendous job with our social security program? Now, I’ll agree there needs to be more accountability within the healthcare insurance field but why take on another enormous taxable burden that frankly will increase an already ridiculous budget deficit? Why not try smaller steps first, such as streamlining documentation and filing, limiting lawsuit amounts, providing proof of citizenship? Why build a bakery when all you need is a cake. The government should regulate the industry not assume the industry.

On government spending – taxpayer money already goes to more than half of total spending. U.S. spending is twice per person what the average industrial nation spends. We’re already paying for national health insurance – but not getting it.

On increasing taxes – taking into account what we’re already paying for premiums, out-of-pocket expenses, co-pays, deductibles – the individual taxes to fund a single payer system would be much less than the present costs for the great majority of individuals. For those who have health insurance, the care would be more comprehensive (medical, vision, dental, mental health, prescription drugs, long term care, chiropractic care, palliative care – in short all necessary care for everyone.) The choice of provider would be expanded. And again, costs reduced for most. For businesses that do not offer health insurance, their taxes would go up but their employees would have health care. For businesses, non-profits and government agencies that now offer full benefits, the taxes would go up, but total health costs would go down. These are not assertions – the data has been studied and verified in several ways.

As far as smaller steps – you can’t cross a chasm in two leaps. There is a chasm between our present crisis and the solutions to resolve it. Single payer is the smallest incremental step to improve our health care.

About the end of the private insurance industry — I urge you to read HR 676, the United States National Health Care Act. The provision for support and training of displaced insurance company workers is up to 2 years of very generous support for each one.

A word on the VA — it is not a single payer system, but a socialized system in which the government owns the hospital, labs, clinics, etc. and pays the doctors and nurses on salary. And the VA boasts the best medical outcomes in the United States for chronic medical disease management. The VA is more like the British National Health Service than the system in Taiwan, for examples. The single payer idea, in distinction, is a publicly owned finance system with PRIVATE delivery of health care (for example: your doctor and partners would still own their practice, the hospital would remain a not-for-profit corporation.)

I love the comment “Why do so many deals need to be struck?”

I think single payer is in fact what we need to reform what Fred correctly calls “medical pricing.” That by itself would save a huge amount of expense. As Fred suggests, because of all the expensive rigamarole- paper pushing, contracts, lawyers, negotiations, advertising, etc.- that goes into those many deals there are enormous efficiencies in this aspect of the change we propose.

The larger point is simply that the care of the sick and the support and preventive care of the healthy is no place for “so many deals.” The unfairness or injustice of the widely different reimbursements for the same procedure depending on the payer — including no access to the procedure if no one will pay — are really what make this nightmare “uniquely American.”

The private insurance companies do pay more for many individual hospital services than Medicare or Medicaid but that doesn’t mean that they’re paid less than it costs them to provide those services. The whole thing about charging for procedures is more about your first point of so many deals being struck. Just because the hospital says it costs $900 and hour to use a specific room doesn’t make it so.

And again –
Single payer is not a perfect system, but it is so much better than the alternative, privatization and profiteering at the expense of the sick.

I disagree. Take a look at Canada,,,,Long Patient Lines,,,Rationed pharmacueticals,,, Again, how can you look at our government and think they will do a better job than private healthcare providers? Given the governments’ propensity for wasting and mismanaging taxpayer dollars? Look at social security,,look at this so-called stimulus package. When do taxpayers get a break????? You know as well as I do that if this became a reality it would cost us more and we would get less for our dollars…. When this program starts running a deficit which of course it will what happens then? Leave it alone. Competition provides choices for us. This will not….

Tom, contrary to popular belief, propagated by industry myths, lawsuits are hardly bankrupting the system, What is bakrupting the system is price-fixing and out-of control advertising, especially by Big Pharma, which is constantly pushing its pills directly on the consumer and inventing conditions that don’t exist and/or don’t need to be controlled chemically.

Here’s where I stand… and I have been pushing this idea for the past two years on the net and in the Media and to my Senator and Congressmen… Expand the Veterans Administration Healthcare System into a National HealthCare System.. Make it compete on the the same playing field as Private. Have a Copay system of say $250 a month for a family of four and free for those making less than $26,641. which is the threshhold amouunt for Veterans seeking care.

Do this instead of the Demoncrat request for Trillions with no oversight of where those trillions will go and to whom..

It probably would take less than 10 billion to Start it up on a nationwide level especially since the VA Hosptials are already located in every State with Testing facilties and Laboratories already in place.. They just need to be expanded, what’s so hard about that!

Plus you have the coverage of the Attorney Generals Office, The Inspector Generals Office, The General Accounting Office as watchdogs…I bet that is the reason the Demoncrat Polticians are ignorng my idea… No chance to pay off their friends or line their pockets as they are with TARP funds.

Here’s why: Example #1 : I had to have three simple “stick” type Blood tests… At my Local General Hospital Outpatient Lab they charged me $921. Three months later same tests at a private Lab $125. Three months later at my Doctors Office who opened his own Lab, $38.
So who is causing the rise in Healthcare.. The Hospitals are!

Example #2: I needed an Ultra-Sound of my Thyroid. General Hospital, $600 for “timed” seven minutes worth of time or $85 a second. And they were scheduled to do 31 procedures that day so they raked in $18,600. The Tech said he averages 20 a day so figure that out weekly and on a yearly level.. The Hospital is making over $3 million dollars just on that one machine…Now we know why Insurance Companies are slowly refusing to pay for Diagnostics.. Again the Hospitals are the problem…

Example #3 My Insurance Company dropped me because the State divided up the State into Hospital Kingdoms to protect the Hospitals and Doctors Profits.. Since I did not live in a Zip Code where my current Medical Provider was located I was dropped…Now because I had a heart attack and Stents inserted 8 years ago I cannot get coverage and the State won’t help me either and they created the problem.. The only Insurance Companies who will take me are from Florida which should ring a bell right away, they only pay up to $100 for a diagnostic test, so if I need another Ultrasound I would have to pay $500.. Which is exactly what happened with the test in Example 2..

Example #4 Then My Doctor wanted a Dye Ultrasound and after that a Biopsy guided Ultrasound, I paid over $1500 and my Insurance Company paid $300. But I pay them over $5000 a year in premiums for nothing! Whose the problem? My Doctor is a great part of the problem cause why didn’t he have all three tests done at once? Because the Doctor who reads the Test Results isn’t on staff or there, so the tests have to be sent to him.. The Doctor who read the test charged me another $375 for six minutes worth of work…multiple that by 31 or $11,625. for 186 minutes or 3.5 hours worth of work just for that day.. So, both the Hospital and the two Doctor’s are the problem in this example…

Example #5. I was a Certified Nurses Assistant in a Private Nursing Home owned by Three Doctors.. 110 Bed facility, rarely an empty bed.. Those Doctors split, after taxes and expenses, $9,531. a month or $3177. each a month! And still they cried Medicare wasn’t paying them enough…$3177 a month is a lot of money to most people… SO whose at fault here.. The Doctors greed.

I have nothing against anyone making money but the Greed in the Medical Profession I believe is beyond belief.. They cry they spent so much on Medical School, well whose fault is that, I didn’t tell which school to go too. and after ten years of working in Hospitals and Nursing homes I yet to meet or see an “Ivy League” Doctor be any better than an Albany Med Doctor except in the amount they billed and their Lordships egos what a bunch of snots…

So along with my idea of expanding the Veterans Administration The VA could also become a legitimate Teaching Hospital turning out Doctors and Nurses and Technicans of all types.. When I worked at Albany Med, the Doctors used to brag that they “practiced on Vet’s” before the paying customers Instead of paying customers, so what;s the difference, The VA could award Scholoarships where the Medical Student would work at their regular salary after graduation for two years then go on with where ever they wanted to go…Thereby assuring the Hosptial has adequate staffing…But Union’s hate that plan because they can’t put a “squeeze” on Management over staffing issues like have done around the nation and force up salaries..

So I shoudl apologize in advance for making sense and coming up with a plan that would work, save money (shame on me) and would be able to be put in operation in a very samll amount of time… I would say a year for the first patient to show up with his or her new National Healthcare Card….And Doctors, and Hospital Administrators, if I hurt your feelings….. To bad, you could care less about mine…..

Another interesting note regarding Doctors and Hospitals… I have heard over the Radio that Doctors and Hospitals and of course Lawyers are the number One cause for family’s to file Bankruptcy… Now that should be a National Embarrasment of great proportions….That Doctor driving down the road with his new Mercedes probably just forced a family out onto to the street and that Hospital Administrator driving that new Beamer can smile all the way home too for he/she just forced a family out on the street… What great people they are aren’t they!

I have a lot to say about this topic but to make it brief…what about the unions (Teachers, Teamsters, Public Employees and other unionized organizations) that have MUCH richer benefits than Medicare provides(I am assuming that by “national health program” you are referring to something similar to, if not exactly the same as Medicare for all Americans)?

For lack of a better word…traditional Medicare benefits SUCK. High deductibles, high coinsurance, high premiums (even for those currently eligible for Medicare). Faced with a serious or terminal illness, the average family would go bankrupt if all they had to fall back on was the current Medicare benefit. The unions will NEVER stand for this. Neither will anyone else with private/not for profit health insurance coverage.

And it’s also needed because even if you are insured, you’re at the mercy of your profit-minded insurer. They — not you — decide what medical care you get. And you are discouraged from getting what they do allow by copays and red tape.

I’m a State worker and supposedly have good health insurance. However, we were sent a long list of things we are supposed to get permission for first. So far, fortunately, as far as I know, I haven’t hit anything on the list but, while no genuis, I’m a reasonably intelligent person and I find it somewhat incomprehensible.

If you live pay to pay on a tight budget, the copays definitely keep you from seeing a doctor.

If you get sick or hurt, between the copay and doctors demanding payment up front, you have no choice but to put it off until pay day at which time it eats into your grocery budget making you eat less nutriously. Often it is not one copay when you see the doctor but two or even three or more as there is one for the office visit, another if you need a blood test or a urine specimen or an x-ray (and so on). If you are desperate enough to go to the ER, if they do cover it instead of deciding you overreacted and should have called them for permission first, that’s an even higher copay plus the regular copay for anything like x-rays and tests the hospital staff deems necessary.

Meanwhile, my daughter (who is unemployed even though she furthered her education and has been diligently looking for work) and grandson on Medicaid can, fortunately, go for the treatment they need. I say fortunately because they both have health care problems and I cannot carry them on my insurance as she aged out of my being able to put her on my coverage and, of course, I never could carry him because legally he’s not my dependent. Because they are on Medicaid, they get the care and the medicine they both need on a regular basis.

I sometimes do and sometimes don’t. I have had to wait months for doctor appointments. I have had a doctor refuse to see me when I insisted he discuss pain management with me instead of telling me to use Tylenol arthritis. This, following my arthritis developing into degenerative bone disease and being referred to him from the ER after I couldn’t walk for two days after years of relying on over-the-counter medication. Not only did he refuse to discuss pain management (interesting enough after he came into an appointment saying let’s discuss surgery, a turn-around that completely surprised me as he had just two appointments previously discouraged surgery that can only be had once in a lifetime because I’m too young for it, and I said no, I want to put that off at least until I retire — a mere four years away) but has bad-mouthed me to at least one primary care who cancelled an appointment I waited months to get. I have another appointment with a provider who specializes in disabled care — in August.

I also was not able to follow-up on recommended physical therapy because it’s a co-pay every time you go and I simply can’t afford $12 two to three times a week. If it’s physical therapy or eat, pay National Grid, pay the rent, it’s physical therapy I’m going to cut, point blank.

My employer has requested forms be filled out for reasonable accommodation for tasks I can’t perform, for even not being on my feet too long. In calling other othopedic specialists, they do not even guarantee they will evaluate let alone fill out the necessary forms. I can understand they can’t know if they’ll fill out something about my limitations but they refuse to even tell me if they will evaluate them or discuss pain management. Meanwhile, while I wait, I wake up in dread of having another morning I wake up unable to walk.

And there are a lot of people out there far, far worse off than I am.

The health care system needs to rid itself of being at the mercy of health insurance companies who want to pay as little as possible and needs to get back to being in business to help the sick and the injured.

Of course, you are right when you say that “Single payer is not a perfect system,” because systems run by human beings for human beings (i.e., families, governments, neighborhoods, churches, etc.) can never be perfect.

However, we can grow, we can improve, we can mature, we can do better. And in the area of health care, universal single payer would be much, much better than any system that exists in the United States today.

@The Original Mike: I totally agree, we need a million people in the streets. So I hope you are participating in the Healthcare-NOW! National Day of Action for Single Payer this Sat., May 30.

Interesting recent article on cost of care — short and long of it in the linked article on the New Yorker — a profit motive on the part of providers drives the cost of care through the roof. A focus on the patient drives the cost of care through the floor. Oddly enough quality of care is inversely related, in this article, to the cost of care (high cost within an area accompanies less benefit/quality/appreciation, low cost within an area accompanies high benefit/quality/appreciation).

I do think that the article downplays the role of a responsible, patient centered administration of insurance but it slams home the point that real cost is driven by providers focusing on their financial bottom line.

Dr. Coates, I’d appreciate your opinion on the article and it’s observations. I am a strong believer that a patient centered system rather than a personal/corporate profit focused system is key to controlling costs. That’s one reason I believe in not for profit health care institutions and insurers.

I’m not so big on a government plan as I believe it will bring it’s own overhead and undertow — inefficiency on a grand scale. In order to really manage cost we do need to change the focus of the system to the patient across the board.